Variations in Prescribing Rates of End-of-Life Medications Among Long-Term Care Residents in Alberta Compared with Ontario-a Retrospective Cohort Study.
Jessica E Simon, Asmita Bhattarai, Zhi-Yun Apoint-Hao, Rhiannon L Roberts, Christina Milani, Colleen Webber, Vivian Ewa, Anna E Clarke, Sarina R Isenberg, Daniel Kobewka, Danial Qureshi, Shirley H Bush, Kaitlyn Boese, Amit Arya, Benoit Robert, James Downar, Peter Tanuseputro, Aynharan Sinnarajah
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引用次数: 0
Abstract
Background: Prescribing rates for subcutaneous medications may be an indicator of quality of end-of-life care in long-term care (LTC). It is not known if this system level measure is valid across jurisdictions. We compared prescribing rates of medications used for end-of-life symptom relief among LTC residents in Alberta and Ontario.
Methods: This retrospective cohort study of LTC residents compared those who died between January 1, 2017, and March 17, 2020 in Alberta, with a published cohort from Ontario. Prescribed end-of-life medications during a resident's last 14 days of life were extracted from administrative dispensation records. LTC homes were ranked into quintiles based on prescribing rates within each home, and the home characteristics were described. The proportion of residents who transferred out of LTC in the last 14 days of life was also determined, as another quality measure.
Results: We identified 10,038 decedents in 117 LTC homes. Among LTC decedents, 16.9% were prescribed ≥1 injectable end-of-life medication and 44.9% were prescribed at least one end-of-life medication by any route of administration, within the last 14 days of life. Across prescribing quintiles, there were no associations with transfer rates prior to death. Comparing Alberta to Ontario, there were markedly lower rates of injectable medicine prescribing (16.9% vs. 64.7%). Potential reasons and data limitations were explored.
Conclusions: Rates of injectable end-of life medication prescribing differed across Alberta LTC homes; however, current provincial data limitations impact the validity of using these rates as a comparative indicator of the quality of end-of-life care.
期刊介绍:
The Canadian Geriatrics Journal (CGJ) is a peer-reviewed publication that is a home for innovative aging research of a high quality aimed at improving the health and the care provided to older persons residing in Canada and outside our borders. While we gratefully accept submissions from researchers outside our country, we are committed to encouraging aging research by Canadians. The CGJ is targeted to family physicians with training or an interest in the care of older persons, specialists in geriatric medicine, geriatric psychiatrists, and members of other health disciplines with a focus on gerontology.